Program

Memphis GEMS

The Memphis GEMS program was created as a culturally relevant intervention to
prevent excess weight gain in pre-adolescent African-American girls. The
program involves highly interactive weekly group sessions with either girls
(child-targeted intervention) or parents/caregivers (parent-targeted
intervention) depending on treatment condition. In an experimental evaluation
of this pilot project, significant impacts were found for sweetened beverage
servings/day, low-fat food practice, physical activity practice, and
over-concern with weight and shape in both forms of the intervention.

DESCRIPTION OF PROGRAM

Target population: African-American girls aged 8 to 10 years with a body mass index (BMI) in the
top 25th percentile and their families.

The intervention is based in Social Cognitive Theory. The child-targeted
intervention involves weekly, 90-minute intervention sessions for the duration
of the 12-week program. The time is broken down as follows: 15-minute
introduction session; 30-minute session titled “Movin’ It” – a hip-hop aerobics
activity designed to get participants physically active; a 30-minute session
titled “Munchin’ It” – a nutrition activity incorporating opportunities for
girls to experience appropriate healthy foods while providing them with the
knowledge and skills necessary to enable them to make healthy lifestyle
modifications; and a 15 minute session called “Taking it Home” where
participants review the concepts of the day, are given small incentives, and are
provided motivation for healthy eating and maintenance of physical activity.

The parent-targeted intervention (titled Eating and Activity Skills for Youth –
EASY) involved similar weekly, 90-minute intervention sessions. The session is
broken down as follows: a 25-minute dance segment titled “EASY Moves” –
participants danced to popular songs from the 70s and 80s and were encouraged to
share popular dances from their youth with their daughters and to learn their
daughters’ current dances and music as a way to connect over physical activity;
two 25-minute sessions including two nutrition programs titled “EASY Tips” – a
didactic nutrition segment focusing on discussion regarding links between
nutrition and parental concerns, and “Easy Fun” – an interactive nutrition
segment alternating food preparation and nutrition-related games; and a
15-minute conclusion used to reinforce key points and to provide take-home
materials.

Evaluated population:
The participants included 60 African-American girls that were 8 to 10 years old
(mean age = 8.9 years) and their parents/caregivers (mean age = 35.5 years).
Child participants all had a body mass index (BMI) in the top 25th
percentile of their age group. Half of the sample lived in a female-headed
household and two-thirds had a family income under $40,000.

Approach:
The Memphis GEMS program evaluation lasted 12 weeks and included a 3-arm
controlled trial (meaning two intervention groups and one control group)
contrasting 2 active, culturally tailored and family-based interventions
focusing on nutrition and physical activity. The first intervention group is
targeted for girls involved in the program (child-targeted intervention),
whereas the other intervention group is targeted for parents of girls aged 8 to
10 years (parent-targeted intervention).

Subjects were randomized into condition (child-targeted intervention,
parent-targeted intervention, or a self-esteem focused control group) at the
outset of the study. Post-intervention outcomes assessed included two physical
body measures (body mass index, and waist circumference), eight measures of
physical activity (Computer Science Applications accelerometer, minutes of
moderate-to-vigorous physical activity, the GEMS Activity Questionnaire to
assess activities performed and the frequency and duration of them, amount of
sweetened beverages, water intake, total energy intake, and percent of calories
from fat), two measures regarding diet and psychosocial variables (low-fat food
practice, and high-fat food practice), five physical activity psychosocial
measures (self-concept, preference, sedentary activity preference, positive
expectancy for physical activity, and self-efficacy for physical activity), and
five body image/weight concern measures (choosing silhouettes that look like
you, choosing silhouettes that you would like to look like, weight concern –
moderate behaviors, weight concern – unhealthy behaviors, and overconcern with
weight and shape).

Results:
The two treatment groups were combined for analysis.One of the eight
physical activity measures was significant – fewer sweetened beverage
servings/day. Of the two diet psychosocial variables, low-fat food practice
showed significant impacts. For the five body image/weight concern measures,
over-concern with weight and shape showed significant impacts. There were no
significant impacts for any of the physical body measures or physical activity
psychosocial variables.

In further analysis, each of the treatment groups was compared separately with
the control group. For the parent-targeted intervention compared with the
control group, one dietary intake variable was significant (sweetened beverage
servings/day), and one body image/weight concern measure was significant
(over-concern with weight and shape).

For the child-targeted intervention compared with the control group, one
physical activity psychosocial variable was significant (physical activity
preference), and one body image/weight concern measure was significant
(over-concern with weight and shape). No other variables were significant.

Finally, comparing the parent-targeted intervention with the child-targeted
intervention revealed one significant impact: low-fat food practice. No other
significant differences were found between the groups.